Rezapour Mohammad, Sepehri Mohammad Mehdi, Khavanin Zadeh Morteza, Alborzi Mahmood
Department of Information Technology Management, Science and Research Branch, Islamic Azad University, Tehran, Iran.
Faculty of Industrial and Systems Engineering, Tarbiat Modares University, Tehran, Iran, & Hospital Management Research Center, Iran University of Medical Sciences, Tehran, Iran.
Med J Islam Repub Iran. 2018 Jul 25;32:62. doi: 10.14196/mjiri.32.62. eCollection 2018.
The kidneys of patients with chronic kidney disease (CKD) do not function well enough and those in end-stage renal disease (ESRD) of CKD need hemodialysis (HD) as a common renal replacement therapy (RRT) procedure. HD requires a vascular access (VA), and arteriovenous fistula (AVF) is the common VA choice in the world due to its very few complications. Despite the widespread use of AVFs, some risk factors maximize AVF failure, which is accompanied by complications of the patient such as repeating VA surgeries and hospitalization. Therefore, finding effective factors in the success of surgery is highly important and, thus, this study aimed at measuring the effect of anastomosis angle on the success of AVF surgery. This study evaluated the effect of conducted angle in an AVF anastomosis on AVF maturation. The images of 48 created AVFs for CKD patients was provided over a one-year period (from May 2016 to April 2017). Cross-tab analysis was used, and significance level was considered meaningful at p-value≤0.001. A centralized database was designed to integrate data. A method for image processing was developed and geometrical characteristics of the vessels (such as anastomosis angle) and also the diameter of artery and vein were measured via AutoCAD 2017 software and exported to the database along with other data. The rate of the AVF failure in the studied patients was 8.96%. The anastomosis angle ≤ 30° is preferable from the AVF status point of view because most AVF maturation (or least AVF failure) rates are detected at this range. This study was performed based on a new approach without the need to measure hemodynamic parameters. Moreover, it signified the important role of anastomosis angle in the function of AVF, showing that the anastomosis angle ≤ 30° is a preferable intraoperative recommendation for AVF surgery.
慢性肾脏病（CKD）患者的肾脏功能不足，而CKD终末期肾病（ESRD）患者需要进行血液透析（HD），这是一种常见的肾脏替代治疗（RRT）程序。HD需要血管通路（VA），动静脉内瘘（AVF）因其并发症极少而成为全球常见的VA选择。尽管AVF被广泛使用，但一些风险因素会使AVF失败的几率最大化，这会给患者带来诸如重复VA手术和住院等并发症。因此，找到手术成功的有效因素非常重要，本研究旨在测量吻合角度对AVF手术成功的影响。 本研究评估了AVF吻合术中的操作角度对AVF成熟的影响。在一年时间内（从2016年5月到2017年4月）提供了48例为CKD患者创建的AVF图像。使用交叉表分析，显著性水平在p值≤0.001时被认为具有统计学意义。设计了一个集中式数据库来整合数据。开发了一种图像处理方法，通过AutoCAD 2017软件测量血管的几何特征（如吻合角度）以及动脉和静脉的直径，并将其与其他数据一起导出到数据库中。 研究患者中AVF失败率为8.96%。从AVF状态的角度来看，吻合角度≤30°是更可取的，因为在此范围内检测到的大多数AVF成熟率（或最低AVF失败率）。 本研究基于一种无需测量血流动力学参数的新方法进行。此外，它表明了吻合角度在AVF功能中的重要作用，表明吻合角度≤30°是AVF手术中一个更可取的术中建议。
